Food Insecurity is a Leading Health-Related Social Need Among Patients With Diabetes

Many of the health-related social needs (HRSNs) of Medicare Advantage beneficiaries with type 2 diabetes (T2D) were associated with quality of care and utilization, according to findings collected from a self-reported screening tool that were analyzed and published in a study published in JAMA Network Open. Self-reported HRSNs can help to assess the social needs of patients with T2D and improve patient care, according to the study authors.

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“We found a high prevalence of HRSNs among beneficiaries with T2D and significant associations between individual HRSNs and measures of quality of care and health care utilization,” the study authors wrote in their analysis.

More than 26% of people aged 65 years and older with T2D face social adversity, according to the study. Previous research demonstrates that adverse social determinants of health (SDOHs) impact the health outcomes of patients with T2D, and improving diabetes-related outcomes should focus on improving SDOHs; however, investigators explain that data of SDOHs are not consistently accurate.

The Centers for Medicare & Medicaid Services (CMS) recently created the self-reported Accountable Health Communities HRSN screening tool to assess factors of HRSNs (food insecurity, transportation, loneliness, financial strain, housing quality) because growing research supports self-reported HRSNs to understand patient health outcomes.

In 2019, investigators analyzed the self-reported HRSNs of 21,528 Medicare Advantage beneficiaries with T2D to analyze the relationship between HRSNs, T2D-related health care quality, and acute care utilization.

Among Medicare Advantage beneficiaries with T2D, 56.9% had 1 HRSN, with financial strain (73.6%), food insecurity (47.5%), and poor housing quality (39.1%) being the most prevalent. Food insecurity was consistently associated with facets of acute care utilization—which include emergency department (ED) visits, inpatient encounters, and avoidable hospitalizations—among beneficiaries.

“Poor diet or food insecurity is associated with development of T2D, increased likelihood of complications, and increased acute care utilization events…in parallel, the physical and economic burdens of living with T2D may make it harder to afford, access, and prepare health-promoting foods,” the study authors wrote.

Factors associated with lower diabetes medication adherence were loneliness, lack of transportation, and utility and housing insecurity. Loneliness and lack of transportation were also associated with increased ED visits.

In addition, more than twice as many people in the HRSN-positive group qualified for disability compared with the HRSN-negative population (46.6% and 22.6%). The positive group also had higher incidence of low-income subsidy (39.6% vs 16.7%) and being Medicare-Medicaid dual eligible (29.7% vs 11.9%).

Study limitations included that self-reported answers are liable to bias and survey nonresponse. In addition, the study excluded those without an Advantage plan, as well as racial and ethnic minority groups who do not read in English or Spanish, the study cannot infer causality, and it does not account for the consequences of the pandemic on utilization.

“Findings from this study may inform future policies and decisions about which HRSNs to screen for and to intervene on for patients living with T2D, maximizing the likelihood that evolving programs address the needs most associated with T2D health outcomes and utilization,” the study authors wrote in the article.

Reference

Ryan J, Franklin S, Canterberry M, et al. Association of Health-Related Social Needs With Quality and Utilization Outcomes in a Medicare Advantage Population With Diabetes. JAMA Netw Open. 2023. doi:10.1001/jamanetworkopen.2023.9316